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Potential Risks and Side Effects of Osteopathic Manual Therapy

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Potential Risks and Side Effects of Osteopathic Manual Therapy Potential Risks and Side Effects of Osteopathic Manual Therapy By: Jimmy Hu For: Dr. Shahin Pourgol NAO DOMP Program January 23, 2015 Introduction Chronic pain is a symptom of modern civilization. Many people have experiences of seeking medical and alternative treatments for pain in the bones. The current standard of practice by modern health professionals is to start with painkillers and muscle relaxants, followed by heat therapy, electrotherapy, physical therapy and ultimately surgery. Those whom suffer from short- term symptoms might be prescribed medications, injections, and physiotherapy, while those whom suffer from long-term symptoms may be referred for surgery or alternative therapies such as Osteopathy, Chiropractic, and Massage Therapy to alleviate outstanding pain. Nonetheless, not all alternative therapies are performed by professionals with medical backgrounds, thus it should be important to address the potential risks and side effects for patients and practitioners in order to prevent an unfavorable outcome. Osteopathic manual therapy (OMT) is used principally in the management of musculoskeletal pain. It can be particularly useful in the elderly, who are more prone to medication side effects. The osteopathic principle states that in order to heal the pain and return your body to normal function, you must correct any structural imbalances within the musculoskeletal system. In truth, painkillers, muscle relaxants, heat therapy, electrotherapy were not designed to correct the imbalance of the body structure. This means that the real reason for the aching pain often has not yet resolved. In order to avoid surgery and completely cure the problem, the body must correct its internal structural abnormality. However, like all other forms of healing, OMT is not without risks and side effects. With the advances in technology, more patients are self-diagnosing their own conditions and seeking different treatments without consulting proper medical advice. In order to ensure safer osteopathic therapy for patients and protect them from unforeseen consequences, it is vital to create a general standard that will help Osteopathic Manual Practitioners to decide when osteopathy is indicated and when it is not. Every therapist should know exactly which risks are involved in their practice and ensure that the patients will benefit from the therapy rather than suffer from its side effects. Potential Risks and Side Effects of Osteopathic Page 1 of 9 Manual Therapy | By: Jimmy Hu What are the Potential Risks and Side Effects of OMT? Osteopathic Manual Therapy is considered one of the safest and most non-invasive forms of alternative medical management. Patients rarely experience side effects. However, no system of medical therapy is free from side effects. Majority of side effects that have been reported occur after a patient has undergone chiropractic treatment on the cervical spine (Ernst 2007). Chiropractors or other manual practitioners who employ these forceful types of techniques use spinal manipulation to treat low back and other musculoskeletal pain (Gatterbauer 2009). It often involves a high velocity, low amplitude thrust accompanied by an expectant cracking or popping sound. In Canada, these forceful spinal manipulation techniques are not utilized in Osteopathy, thus major side effects are dramatically less. OMT focuses on the use three main clinical techniques; they are Mobilization, Muscle Energy Techniques (MET), and Soft-Tissue Techniques. These techniques are gentle and aim to alleviate the dysfunction of the musculoskeletal system, including the spine, joints, muscles, tendons, ligaments, and fascia, while taking into account the individual needs of each patient (Gatterbauer 2009). It is not unusual for the patients to feel less optimal before they begin to feel better after therapy. The body requires time to process the therapeutic inputs and adjust itself toward a state of homeostasis. As the body recovers, symptoms may exacerbate and physiologic metabolisms may fluctuate. It is typical for some patients to experience localized tenderness, stiffness, numbness, weakness, headaches, diarrhea, and menstrual changes (Carnes, Mars et al. 2010). Two recent studies investigated patients’ responses to treatment. General Osteopathic Council (UK) conducted a systematic review based on 8 cohort studies and 31 randomized controlled trials that explored the incidence and risk of adverse events with manual therapies. The study found the risk of major adverse events to be lower than taking medication and around half of patients experience minor to moderate adverse effects within 24 hours after manual therapy, but resolve within 72 hours (Carnes, Mars et al. 2010). While the study did not distinguish osteopathic manual therapy from the other types of manual therapy, it is for certain that the documented events have come from professions that uses spinal manipulation. Another study done by the European School of Osteopathy found that 93% of patients reported at least one adverse event following treatment at an osteopathic teaching clinic. The results are based on 52 adult patients who have experienced an “additional effect after treatment”. Below is a chart that illustrates the most commonly patient-observed side effect after manual osteopathy (Rajendran, Mullinger et al. 2009). Potential Risks and Side Effects of Osteopathic Page 2 of 9 Manual Therapy | By: Jimmy Hu 2009 PATIENT-OBSERVED SIDE EFFECTS AFTER MANUAL OSTEOPATHY 30 25 LocalPain 20 LocalStiffness 15 Worsening Worsening ofPain 10 Headedness - General General Pain/Discomfort Tiredness Headache Light PERCENTAGE OF PATIENTS OF PERCENTAGE 5 0 SIDE EFFECTS The incidence of most adverse events to treatment ranges from a day to a week. Majority of the side effects were gone after 7 days post-treatment. Although the side effects are relatively rare, patients should be made aware of these experiences. Utilizing gentle osteopathic techniques further reduces the occurrences of these symptoms. The study demonstrated how common it is for some patients to experience mild muscle soreness, fatigue, or tenderness, similar to delayed onset muscle soreness after excessive exercises. It should be important to point out that manual osteopathy cited in most international journals and articles have come from research within manual medicine. The term manual osteopathy used in Canada does not offer the same weight as manual osteopathy observed elsewhere. This is because manual osteopathy is generally performed by osteopathic physicians and other professions that utilizes spinal manipulation. In contrast, spinal manipulation can only be legally performed by chiropractors in Canada. Osteopathic Manual Practitioners in Canada practice a form of manual osteopathy without spinal manipulation and devoid of any kind of high velocity maneuvers. OMT are generally more rhythmical and softer when compared to its Chiropractic counterpart (Pourgol 2014). Even so, manual osteopathy is still very dependent upon the skill of the practitioner. Potential Risks and Side Effects of Osteopathic Page 3 of 9 Manual Therapy | By: Jimmy Hu What are the Contraindications of OMT? Osteopathy uses very gentle techniques that work on the musculoskeletal system. There are not a great number of contraindications in OMT. Techniques that rank the highest in the number of contraindications are high velocity thrust techniques, which do not apply to OMTs in Canada. In medicine, there is a distinction between an "absolute" and a "relative" contraindication. An absolute contraindication means that a therapeutic method must never be used for a conflicting condition that will result in a fatal consequence. A relative contraindication means that the risks of the therapy have to be carefully assessed such that the benefits to the patient will outweigh the risks after it is initiated. Although OMT is a highly safe procedure, there are still many potential risks associated with its use. Not only will the client not benefit from such therapy, but can suffer serious complications. The primary risk identified in the literature is hyperextension coupled with rotation of the upper cervical spine due to concern regarding potential occlusion of the vertebral artery (Rothwell, Bondy et al. 2001, Chila and Association 2010). Below are the major considerations for manual osteopaths to be aware of when performing OMT. Even though the Canadian osteopathic profession does not permit spinal manipulation or high velocity techniques, these conditions can still pose serious threats to general osteopathic practices. Commonly accepted contraindications include the following: 1. Poor blood circulation, especially in Vertebrobasilar Artery: If the patient suffer from dizziness, nausea, vomiting, diplopia and other similar phenomena when the neck is extended and turned, it means that half of the blood vessels supplying the hindbrain are narrowed or blocked. In this case the patient should not undergo any cervical manipulation, otherwise there is a potential risk of a stroke (Gatterbauer 2009). 2. Aneurysms and Severe Cardiovascular Diseases: An improper maneuver can cause an aortic aneurysm to rupture, particularly an abdominal aortic aneurysm. These patients often have a history of diabetes and back pain is often accompanied by abdominal pain. An abdominal ultrasound or computerized tomography will be needed for confirmation when suspected, this it would be important to recognize the red flags and know when to refer to a family physician. Some literature
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